This. The EMR does go down from time to time. We still have paper order pads around so that things can get done. Its annoying AF. You have to fax things to radiology to get a scan. You have to walk to pharmacy to get meds. But, the system worked before computers (which wasn't that long ago in many hospitals) and it works without them today.

That said , the first time I had to use paper I felt like I had no idea what I was doing, because a lot of the EMR defaults aren't there to prompt you. So you have to specify a 'start time' for a medication, but in the EMR now is the default, so I didn't think about it as anything mandatory.

Downtime procedures are definitely a thing in the US. Known downtime is certainly the best time to prepare and practice, this happens when an EMR goes through an upgrade and migrations are run. This can be 6-24 hours.

There are bundled minor upgrades (think service packs) that have short (10-60 minute) downtimes, blocking migrations run in that time but are kept to a minimum. If it is at all possible, migrations will be async (even on major upgrades) and run in the background after the new version goes live.

During downtime, bloodwork and the like involve pre-allocated barcode labels. Either the results will be accessible on the instrument afterwards in its memory, or the results will be printed out and it is up to the lab tech to transcribe the results.

I can't speak in depth for radiology, but I expect that they have file share servers involved for the raw results. Likely less local memory (in number of results that can be stored) than clinical lab instruments.

You can ventilate or have light in manual downtime. You don't have immediate access to any advanced stuff. And that's for very specific catastrophic situations. In grey zones where things half work and emergency protocols have not been activated, the hospital is almost completely stalled.